Provider Demographics
NPI:1215276944
Name:SPEAKS ORTHODONTICS LLC
Entity type:Organization
Organization Name:SPEAKS ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:SPEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-496-3335
Mailing Address - Street 1:2763 KING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3141 N. IRVING ST.
Practice Address - Street 2:STE. 201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211
Practice Address - Country:US
Practice Address - Phone:720-496-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9291261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32139853Medicaid